La mortalité

Le lien entre survenue d’une MTEV chez les patients cancéreux et la mortalité a été pour la première fois étudié par Sorensen et al. [53]. Dans cette étude basée sur la population du Danemark, les patients cancéreux atteints de MTEV ont été comparés aux patients atteints de cancer qui n'ont jamais développé de MTEV. Les patients et les témoins ont été appariés selon le type de cancer, l'âge, le sexe et l'année du diagnostic du cancer.

Le taux de survie à 1 an était de seulement 12% chez les patients ayant eu un cancer au moment de la MTEV, comparativement à 36% dans le groupe témoin sans MTEV. Cette différence est également constatée chez les patients dont le cancer est diagnostiqué dans l’année qui suit l’épisode thromboembolique veineux (Figure 1-16).

En revanche, aucune différence en terme de survie n’est mise en évidence quand le diagnostic de cancer est porté plus d’un an après l’épisode.

Figure 1-16 : Estimation du pourcentage de survie du patient cancereux en fonction du moment du diagnostic du cancer (d’après Sorensen et al.2000)

41 De même dans l’analyse de survie des patients avec cancers pulmonaires non à petites cellules de Blom et al. [54], le risque de décès des patients ayant présenté une MVTE est multiplié par trois à quatre par rapport aux patients non atteints de MVTE, cette différence étant retrouvée à la fois chez les patients au stade de cancer métastatique et chez les patients n'ayant pas de métastases. Bien que quelque peu contre-intuitif, l'impact de la MTEV sur la survie est plus élevé chez les patients diagnostiqués avec un cancer au stade local, et plus petit parmi les cancers métastatiques [3,55-58]. Le risque de MTEV associé au cancer est donc multifactoriel.

42

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